Healthcare Provider Details

I. General information

NPI: 1992668222
Provider Name (Legal Business Name): FOOT & ANKLE SPECIALISTS OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4869 WILLIAMS DR STE 105
GEORGETOWN TX
78633-2432
US

IV. Provider business mailing address

7942 W BELL RD STE C5-424
GLENDALE AZ
85308-8708
US

V. Phone/Fax

Practice location:
  • Phone: 512-759-8220
  • Fax: 844-498-2130
Mailing address:
  • Phone: 512-759-8220
  • Fax: 844-498-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SEAN BROWN
Title or Position: CEO
Credential:
Phone: 512-759-8220